GILBERT: Courage and cowardice in health exchange debate

The year-and-a-half odyssey over Michigan government's role in running the health insurance exchange required by Obamacare is a classic study in political courage and cowardice.

Through it, Oakland County constituents can learn a lot about their representation.

In particular, a key vote occurred Feb. 28 in the Michigan House of Representatives on a proposed federal-state health exchange that illustrates current divisions in the Republican Party.

Most Oakland County Republicans stood up to their party's Tea Party faction on that vote, which these days takes a fair measure of courage.

The same cannot be said for their colleagues in the Senate.

The 78-31 House vote approving a joint exchange to implement the Affordable Care Act also demonstrated bipartisanship.

Fifty of the 51 Democrats and 27 of the 59 Republicans supported the measure while 30 Republicans and one Democrat opposed it.

However, the plan died when it failed to come to a vote in the Senate. The upshot is that Michigan will be stuck with a federally run exchange.

There are a couple of ironies in the situation.

First, the vote reflects a turnabout from what House Republicans were accused of when they failed to approve a state-run health exchange last year. Then the shoe was on the other foot as advocates accused House members of caving in to the Tea Party.

Second, Senate Republicans have opted for a health-care solution that will offer less consumer choice when Obamacare takes effect next year. They have put the federal government in charge due to their inaction. The fact that Michigan will have no role in running the exchange is likely to reduce competition among health insurers and, therefore, drive up prices for those in the individual health insurance market, either because their employer offers no coverage or they lack coverage for other reasons.

Normally -- according to them, at least -- it is Republicans extolling the virtue of competition while Democrats prefer regulated markets.

Politics clearly trumped philosophy in this case -- not to mention common sense.

In another twist, State Rep. Gail Haines, R-Lake Angelus, and State Sen. Jim Marleau, R-Lake Orion, traded leadership roles in the course of the health exchange debate over the last year.

Marleau originally championed a pure state-run exchange with his Senate Bill 693 last year. Indeed, the Senate passed it, but the House balked. Marleau even chided the House for its inaction, including Haines as a target. Haines is chairwoman of the Health Policy Committee, which reviewed the legislation, and Marleau accused her of only acting at the behest of House Speaker Jase Bolger.

However, Haines tireless pushed hard for the legislation after the election, trying to educate her colleagues to the fact that Michigan citizens would be best served by having a voice in how Obamacare is implemented. It is, after all, the law of the land, though some foes apparently think it will go away if they just scream loud enough. It won't.

Haines eventually ended up in a minority of House Republicans favoring SB 693.

When that course failed, Gov. Rick Snyder advocated a joint federal-state exchange, resulting in the bipartisan House approval of House Bill 4111, which embodied the concept.

But then Marleau and his colleagues who dropped the ball, Haines said, because they were "trying to please the Tea Party."

Tea Party leaders in the state and nationally have threatened GOP lawmakers who deviate from their anti-government orthodoxy with primary election opposition.

Marleau said he thinks it would have been better if the Senate had agreed to the joint federal-state exchange, and the state sacrificed a $31 million federal grant that would have helped set it up.

"If you can have a seat at the table, it is better than being the meal on the table," Marleau said. He admitted the political climate -- all senators not term-limited face election next year -- probably played a factor in the demise of the legislation.

For the record, here is how the Oakland County House delegation voted on HB 4111 to create a joint federal-state exchange: